Abstract

Introduction and hypothesis

The objective was to evaluate the impact of body mass index (BMI) on the subjective improvement and risk of reoperation after first-time mid-urethral sling surgery.

Methods

Data were retrieved from the national Danish Urogynaecological Database, including women with first-time surgery with mid-urethral polypropylene slings from 2011 to 2016. The subjective improvement was assessed by the difference in symptoms based on the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) completed pre- and 3 months postoperatively. A reoperation was defined as any new surgical procedure for stress urinary incontinence performed within the study period.

Results

During the study period, 6,414 mid-urethral sling procedures were performed; 80.0% of these women filled out both pre- and post-surgical International Consultation on Incontinence Questionnaire (ICI-Q) forms. 42.4% had a BMI < 25, 34.6% had BMI 25–30, 16.9% had BMI 30–35, and 6.0% BMI >35. The subjective improvement after surgery was high in all BMI categories and there were no differences between the categories. The overall cumulative hazard proportion at 2 years of follow-up was 1.9% (CI 95%: 1.6–2.3) and after 5 years 2.4% (CI 95%: 2.0–2.9). Adjusted for age, smoking, and use of alcohol, the cumulative hazard proportion after 2 years of follow-up was 3.2% (CI 95%: 1.6–6.2) for women with BMI >35 and after 5 years 4.0% (CI 95%: 2.0–7.7), which was the highest proportion of reoperation in the study. The crude hazard ratio was 1.84 (CI 95%: 0.89–3.83) women with BMI >35 and the adjusted hazard ratio was 1.94 (CI 95%: 0.92–4.09).

Conclusions

We found high subjective improvement after the first-time surgery unrelated to BMI. Women with a BMI over 35 had the highest proportion of reoperations, although this was not statistically significant.

Notes

Acknowledgements

The study was supported by the Program for Clinical Research Infrastructure (PROCRIN) established by the Lundbeck Foundation and the Novo Nordisk Foundation.

Compliance with ethical standards

Conflicts of interest

Dr Weltz had travel expenses paid for by Astellas for EUGA Congress 2016. Dr Guldberg has accepted grants from Astellas and Pierre Fabre, Dr Lose has accepted payment for research from Astellas and worked as a consultant for Contura. The remaining authors claim that they have no conflicts of interest.

Appendix

Table 4

Surgical procedures according to the Danish Nordic Medico-Statistical Committee (NOMESCO)

Number

Procedure

KLEG10

Vaginal urethrocystopexy with use of sling

KLEG10A

Vaginal urethrocystopexy with use of sling through the obturator foramen